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4 <br /> i '715/X002 14:35 2094118 AGE STOCKTON `' PAGE 01/01 <br /> e`t+o goo NVreER <br /> SAN JOAQUIN COUNTYPUBLIC 14EALT ViCES <br /> .- ENVIRONMENTAL HEALTH DIVI310 J (��E <br /> 304 EAST WEBER AVENUE,THIRD FLOG I►ll IS ���D <br /> 13ST0CKrON CA 95202 4A <br /> (209)468420 AUL 1 S 200 <br /> CLIC RECORDS RELEASE APPUCATiON 2 <br /> APPLICANT U <br /> U HEALTH <br /> ?7 <br /> ADDRESSES <br /> / <br /> PHONE �Q FACSIMILE 1 - <br /> If V war <br /> TENTATIVE'APPOINTMENT.DATE '711012- <br /> "M. (D•'D D , <br /> (Pl�ae T f01b filam9a of apallAtIon butunittol) <br /> CHECK BOX TO EXPEDITE RE QU W-00 -0P sOIN3 SSiNM DAYS <br /> SIGNATURE OF APPLICANTAb DA7E / <br /> FILE ADDRESS <br /> 261qw- %I 11 <br /> ry <br /> A0 Ififinkri <br /> . ID <br /> ✓✓ <br /> or <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> tJNummouNo TANK(UST)CLEANUP SIS(LOP) O HOUSING ABATEMENT ❑ SOUD WAM FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) O FOOD FACILITY O SOLID WASTE VEHICLE <br /> UNDERGROUND TANK RAONITORING IREMovAL) D DOG KENNEL. G DAIRY <br /> HAZARDOUS WASTE GENERATOR <br /> CHICKEN RANCH 0PKG TREATMIENT PLANT <br /> TIERED PERMITTED FACILITY E3MOTELMOTEL b PUMPER TRtiCK/1fAflWCHt?lA TOii-87$ <br /> Q TATTOOIBODY PLgRCiNG ❑ POOLISPA la LAND USE APPLICATION S"S <br /> i3 MEDICAL WASH FACILITY ❑ PUBLIC WATER SYSTEM IS OTHER(PLEASE WE-CiF'Y ABOVE) <br /> 1. List up to ten addresses In the space above. Select the type(s)of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. ��"•^�' 138 or mall to the <br /> ddrass iogl d above. <br /> 2. EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed <br /> approximately five business days but no later than ten(10)days after receipt of apPlicatlon. The files <br /> will be field for a maximum of five business days for review. Appointments should be scheduled . <br /> accordingly. <br /> 3. A file that Is actively being worked on by END staff may not be Immediately available for review. A new <br /> application may be submitted when the file is available. <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD staff at fife+lucpense <br /> of the applicant. Future file reviews by the same applicant may require a$78.04 deposit prior to review. <br /> ' 5. 'TENTATIVE Appointment dates must be-confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> .o 14 evOW6 <br />